Survivors

These days, Amy Vartorella has a different definition of a romantic evening with her husband, David Johnson. And it isn^t just 13 years of marriage and three kids that have colored her thinking.

In the past, a romantic evening would have included intimacy. Now, she^s happy going to dinner and a movie and spending time with him. After a long struggle to recover from cervical cancer, the Ohio couple is still in the process of reclaiming their intimate life.

Resuming sexual relations after cancer, especially gynecologic cancer, isn^t easy, as Amy, a nurse, knows firsthand. It can take some time due to pain and psychological roadblocks.

Amy^s diagnosis of cervical cancer in late 2000 was followed by complications that required bowel surgery and removal of an ovary. Those procedures were in addition to the cervical cancer treatment, which included a radical hysterectomy, chemotherapy and radiation.

About six weeks after treatment ended, she decided it was time to resume their sex life. "I wanted to prove I was done," she says, still remembering how painful it was to attempt intercourse. These days, it^s getting more comfortable, but she says they are still getting back to normal. So if an evening out means dinner, a movie and time spent together, that^s OK. "It means we are on our way," says the upbeat Vartorella.

As a nurse, Vartorella is better informed about the aftermath of cancer than most, but still found the struggle to regain sexuality frustrating.

As an ongoing study at Ohio State University suggests, Vartorella – who was part of the research -- is far from alone.

Sexual adjustment after cancer treatment is a problem for many couples, says Barbara Andersen, a psychologist on staff at the university^s Comprehensive Cancer Center. For nearly 20 years, Andersen and her co-researchers have followed cancer patients, asking them about how they regain intimacy and the roadblocks along the way.

In one of their recent studies, they followed 150 women referred to a gynecologic oncologist at one of two institutions affiliated with Ohio State; half had gynecologic cancers, while the others were diagnosed with benign gynecologic problems.

Andersen asked all the women, aged 23 to 80, to answer questions about their personality and their sexuality and then followed those with a cancer diagnosis for 12 months. "Twenty to 40 percent had sexual problems," Andersen found. Loss of desire, arousal difficulties and orgasmic difficulties were common.

And the problems don^t disappear quickly, she found. Often they persisted at the 12-month follow-up.

Perhaps not surprisingly, those with sexual difficulties before the diagnosis had the most problems making an adjustment after cancer treatment. Those who had more symptoms of depression at the time of diagnosis had more problems adjusting, as did those who had supplemental therapy such as radiation.

"The women who receive pelvic irradiation are at higher risk of sexual problems because of the changes to the pelvis," Andersen says. "The blood vessels in the tissues shrink," making it harder to become aroused.

While health-care providers may not even address the issue, Andersen says they are becoming more aware of the need to discuss sexuality with their cancer patients. Textbooks now include information on the topic, whereas they did not 20 years ago, she says.

She suggests that women not wait for their doctor to broach the subject. Instead, they should ask, and if they have treatment options, ask further about each treatment^s effect on later sexuality.

"If they ask a physician and he doesn^t know [about sexuality issues], press the physician for a referral to someone who does know," Andersen suggests. Sometimes, solutions can be simple: using a lubricant, a measure that might not occur to younger cancer patients, or adjusting lovemaking times to account for the fatigue many cancer patients experience in late afternoon or evening.

Another expert agrees that health-care providers are becoming more aware of the need to discuss sexuality issues, but they^re not yet perfect. So Paula J. Anastasia, a nurse specialist for gynecologic oncology patients at Cedars- Sinai Medical Center in Los Angeles, suggests that anyone with cancer should ask the following questions of her physician: How will the cancer diagnosis affect my sexual functioning? When can we resume our intimate relationship? Are there any risks or problems of which I should be aware?

Communicating with your partner, plus knowing the problems are common, can help, too, experts say, as can just knowing it takes everyone a while to get back to normal.

It helped Amy Vartorella to know that others have the same problems. "Everyone I talk to [who has undergone treatment for cancer], we^re in the same boat," she says. Open communication with her husband, she says, has also been key for her. "We both know it^s going to get better, "she says.